Irving Kirsch#Response expectancy theory

The son of Jewish immigrants from Poland and Russia, Kirsch was born in New York City on March 7, 1943. Kirsch received his PhD in psychology from the University of Southern California in 1975. While a graduate student, he produced, in conjunction with the National Lampoon, a hit single and subsequent record album entitled The Missing White House Tapes, which were crafted by doctoring tape recordings of Richard Nixon’s speeches and press conferences during the Watergate hearings. The album was nominated for a Grammy award as Best Comedy Recording in 1974.

In 1975, Kirsch joined the psychology department at the University of Connecticut, where he worked until 2004, when he became a professor of psychology at the University of Plymouth. He moved to the University of Hull in 2007 and joined the faculty of the Harvard Medical School in 2011. Kirsch has authored or edited 10 books and more than 200 scientific journal articles and book chapters."Irving Kirsch Biography." Integrative Medicine & Health 2012. Web. 26 Mar. 2012. [https://web.archive.org/web/20120425220734/http://imconsortium-congress2012.org/biography-irving-kirsch.html]

Kirsch’s response expectancy theory is based on the idea that what people experience depends partly on what they expect to experience.{{sfn|Kirsch, I|1985}} According to Kirsch, this is the process that lies behind the placebo effect and hypnosis. The theory is supported by research showing that both subjective and physiological responses can be altered by changing people’s expectancies.{{cite book |editor=Kirsch I |title=How expectancies shape experience |publisher=American Psychological Association |location=Washington DC |year=1999 |page=431 |isbn=1-55798-586-3}} The theory has been applied to understanding pain, depression, anxiety disorders, asthma, addictions, and psychogenic illnesses.

Kirsch’s analysis of the effectiveness of antidepressants was an outgrowth of his interest in the placebo effect. His first meta-analysis was aimed at assessing the size of the placebo effect in the treatment of depression.{{Cite journal |vauthors=Kirsch I, Sapirstein G |title=Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication |journal=Prevention and Treatment |volume=1|issue=2|date=1998-06-26|pages=Article 0002a|doi=10.1037/1522-3736.1.1.12a|url=http://journals.apa.org/prevention/volume1/pre0010002a.html|archive-url=https://web.archive.org/web/19980715085305/http://journals.apa.org/prevention/volume1/pre0010002a.html |archive-date=1998-07-15 }} The results not only showed a sizeable placebo effect, but also indicated that the drug effect was surprisingly small. This led Kirsch to shift his interest to evaluating the antidepressant drug effect.

The controversy surrounding this analysis led Kirsch to obtain files from the U.S. Food and Drug Administration (FDA) containing data from trials that had not been published, as well as those data from published trials. Analyses of the FDA data showed the average size effect of antidepressant drugs to be equal to 0.32, clinically insignificant according to the National Institute for Health and Clinical Excellence (NICE) 2004 guidelines, requiring Cohen's d to be no less than 0.50.{{cite journal |vauthors=Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT |title=Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration |journal=PLOS Medicine|volume=5 |issue=2 |pages=e45 |date=February 2008 |pmid=18303940 |pmc=2253608 |doi=10.1371/journal.pmed.0050045 |doi-access=free }} No evidence was cited to support this cut-off and it was criticised for being arbitrary;{{cite journal |last1=Turner |first1=Erick H |last2=Rosenthal |first2=Robert |title=Efficacy of antidepressants |journal=BMJ |date=8 March 2008 |volume=336 |issue=7643 |pages=516–517 |doi=10.1136/bmj.39510.531597.80|pmid=18319297 |pmc=2265347 }} NICE removed the specification of criteria for clinical relevance in its 2009 guidelines.{{cite journal |last1=Cuijpers |first1=Pim |title=What is the Threshold for a Clinically Relevant Effect? The Case of Major Depressive Disorders |last2=Turner |first2=Erick H. |last3=Koole |first3=Sander L. |last4=van Dijke |first4=Annemiek |last5=Smit |first5=Filip |journal=Depression and Anxiety |date=May 2014 |volume=31 |issue=5 |pages=374–378 |doi=10.1002/da.22249|pmid=24677535 |s2cid=205736292 |doi-access=free }}{{cite journal |last1=Moncrieff |first1=Joanna |last2=Kirsch |first2=Irving |title=Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences |journal=Contemporary Clinical Trials |date=1 July 2015 |volume=43 |pages=60–62 |doi=10.1016/j.cct.2015.05.005 |pmid=25979317 |issn=1551-7144|doi-access=free }}

Kirsch challenges the chemical-imbalance theory of depression, writing "It now seems beyond question that the traditional account of depression as a chemical imbalance in the brain is simply wrong."{{cite book | title=The Emperor's New Drugs: Exploding the Antidepressant Myth | publisher=Basic Books | date=2010 | last=Kirsch | first=Irving | pages=[https://archive.org/details/emperorsnewdrugs0000kirs/page/80 80] | isbn=978-0-465-02016-4 | title-link=The Emperor's New Drugs: Exploding the Antidepressant Myth }} In 2014, in the British Psychological Society's Research Digest, Christian Jarrett included Kirsch's 2008 antidepressant placebo effect study in a list of the 10 most controversial psychology studies ever published.{{cite web|url= http://digest.bps.org.uk/2014/09/the-10-most-controversial-psychology.html|title= The 10 most controversial psychology studies ever published|last1= Jarrett|first1= Christian|date= 19 September 2014|website= Research Digest|publisher= British Psychological Society|access-date=7 October 2014}}

In September 2019 Irving Kirsch published a review in BMJ Evidence-Based Medicine, which concluded that antidepressants are of little benefit in most people with depression and thus they should not be used until evidence shows their benefit is greater than their risks.{{cite journal |last1=Jakobsen |first1=JC |last2=Gluud |first2=C |last3=Kirsch |first3=I |title=Should antidepressants be used for major depressive disorder? |journal=BMJ Evidence-Based Medicine |pages=bmjebm-2019-111238 |date=25 September 2019 |volume=25 |issue=4 |doi=10.1136/bmjebm-2019-111238 |pmc=7418603 |pmid=31554608|doi-access=free }}

Kirsch has focused some of his research on the topic of hypnosis. The basis of his hypnosis theory is that placebo effects and hypnosis share a common mechanism: response expectancy. Kirsch's idea on this topic is that the effects of both hypnosis and placebos are based upon the beliefs of the participant.{{cite journal |author=Kirsch , Irving|title=Hypnosis and Placebos: Response Expectancy as a Mediator of Suggestion Effects |journal=Anales de Psicología |volume=15 |issue=1 |pages=99–110 |year=1999|url=http://www.um.es/analesps/v15/v15_1pdf/10h08kirsch.pdf}} He has characterized clinical hypnosis as a "nondeceptive placebo."{{cite journal |author=Kirsch I |title=Clinical hypnosis as a nondeceptive placebo: empirically derived techniques |journal=American Journal of Clinical Hypnosis |volume=37 |issue=2 |pages=95–106 |date=October 1994 |pmid=7992808 |doi=10.1080/00029157.1994.10403122}}

• David Healy
• John Ioannidis

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• {{cite journal |author= Hall, K. T. |author2= Lembo, A. J. |author3= Kirsch I. |author4= Ziogas, D. C. |author5= Douaiher, J. |author6= Jensen, K. B. |name-list-style=amp|title=Genetic variation at the coronary artery disease risk locus GUCY1A3 modifies cardiovascular disease prevention effects of aspirin|journal=PLOS Medicine|volume=7 |issue=10 |pages=e45 |date=October 2012 | doi=10.1371/journal.pone.0048135 |pmid= 23110189 |doi-access=free |pmc=3479140 }}
• {{cite book |author=Kirsch, I|title=The Emperor's New Drugs: Exploding the Antidepressant Myth |publisher=The Bodley Head |location=London |year=2009 |isbn=978-1-84792-083-6|title-link=The Emperor's New Drugs }}
• {{cite journal |author=Kirsch, I. |author2=Deacon, B. J. |author3=Huedo-Medina, T. B. |author4=Scoboria, A. |author5=Moore, T. J. |author6=Johnson, B. T |name-list-style=amp|title=Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration |journal=PLOS Medicine|volume=5 |issue=2 |pages=e45 |date=February 2008 |pmid=18303940 |pmc=2253608 |doi=10.1371/journal.pmed.0050045 |doi-access=free }}
• {{cite journal |author=Kirsch, I. |author2=Moncrieff, J |name-list-style=amp|title=Clinical trials and the response rate illusion |journal=Contemporary Clinical Trials |volume=28 |issue=4 |pages=348–51 |date=July 2007 |pmid=17182286 |doi=10.1016/j.cct.2006.10.012}}
• {{cite book |author=Lynn, S. J. |author2=Kirsch, I |name-list-style=amp|title=Essentials of Clinical Hypnosis: An Evidence-based Approach|publisher=American Psychological Association (APA) |location=Washington, DC |year=2005|isbn=1-59147-344-6}}
• {{cite journal |author=Kirsch, I. |author2=Moore, T. J. |author3=Scoboria, A. |author4=Nicholls, S. S |name-list-style=amp |title=The emperor's new drugs: An analysis of antidepressant medication data |journal=Prevention and Treatment |volume=5 |pages=Article 23 |date=July 2002 |doi=10.1037/1522-3736.5.1.523a |url=http://alphachoices.com/repository/assets/pdf/EmperorsNewDrugs.pdf |access-date=2013-01-09 |archive-date=2012-12-24 |archive-url=https://web.archive.org/web/20121224181847/http://alphachoices.com/repository/assets/pdf/EmperorsNewDrugs.pdf |url-status=dead }}
• {{cite journal|author=Kirsch, I.|author2=Braffman, W|name-list-style=amp|title=Imaginative Suggestibility and Hypnotizability|journal=Current Directions in Psychological Science|volume=10|issue=2|year=2001|pages=57–61|doi=10.1111/1467-8721.00115|s2cid=145383389}}
• {{cite journal |author=Kirsch, I. |author2=Lynn, S. J |name-list-style=amp|title=Automaticity in clinical psychology |journal=American Psychologist |volume=54 |issue=7 |pages=504–15 |date=July 1999 |pmid=10424156 |doi=10.1037/0003-066x.54.7.504}}
• {{cite book |editor=Kirsch, I.|title=How expectancies shape experience |publisher=American Psychological Association |location=Washington DC|year=1999|isbn=1-55798-586-3}}
• {{Cite journal |author=Kirsch, I. |author2=Sapirstein, G |name-list-style=amp|title=Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication |journal=Prevention and Treatment |volume=1|issue=2|date=1998-06-26|pages=Article 0002a|doi=10.1037/1522-3736.1.1.12a|url=http://journals.apa.org/prevention/volume1/pre0010002a.html|archive-url=https://web.archive.org/web/19980715085305/http://journals.apa.org/prevention/volume1/pre0010002a.html |archive-date=1998-07-15 }}
• {{cite journal |author=Kirsch, I. |author2=Lynn, S. J |name-list-style=amp|title=Dissociation theories of hypnosis |journal=Psychological Bulletin |volume=123 |issue=1 |pages=100–15 |date=January 1998 |pmid=9461855 |doi=10.1037/0033-2909.123.1.100}}
• {{cite journal|author=Kirsch, I.|author2=Lynn, S. J|name-list-style=amp|title=Social-cognitive alternatives to dissociation theories of hypnotic involuntariness|journal=Review of General Psychology|volume=2|issue=1|year=1998|pages=66–80|doi=10.1037/1089-2680.2.1.66|s2cid=210783110}}
• {{cite journal|author=Montgomery, G. H.|author2=Kirsch, I|name-list-style=amp|title=Mechanisms of placebo pain reductio: An Empirical Investigation|journal=Psychological Science|volume=7|issue=3|year=1996|pages=174–176|doi=10.1111/j.1467-9280.1996.tb00352.x|s2cid=73165388}}
• {{cite journal|author=Kirsch, I.|author2=Lynn, S. J|name-list-style=amp|title=Altered state of hypnosis: Changes in the theoretical landscape|journal=American Psychologist|volume=50|issue=10|year=1995|pages=846–858|doi=10.1037/0003-066X.50.10.846}}
• {{cite book|author=Kirsch, I|title=Changing expectations : A key to effective psychotherapy|publisher=Brooks/Cole|location=Pacific Grove, CA|year=1990|isbn=0-534-12648-0|url-access=registration|url=https://archive.org/details/changingexpectat00kirs}}
• {{cite journal|author=Kirsch, I|title=Response expectancy as a determinant of experience and behavior|journal=American Psychologist|volume=40|issue=11|year=1985|pages=1189–1202|doi=10.1037/0003-066X.40.11.1189}}

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• [https://www.facebook.com/irving.kirsch Irving Kirsch - Facebook]
• [http://www.programinplacebostudies.org Program in Placebo Studies and the Therapeutic Encounter website]
• CBS News 60 Minutes - Treating Depression: Is there a placebo effect? February 19, 2012 4:22 PM (Irving Kirsch interview) [http://www.cbsnews.com/video/watch/?id=7399362n]
• [https://vimeopro.com/mghpsychiatry/mghpsychiatry/video/167171571 Are Antidepressants Effective? Kirsch's debate with Peter Kramer]

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Category:1943 births

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